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Emerging Periodontal Trends

New research is demonstrating that a person’s total health is indeed related to his or her oral health. Elimination of all oral infections, including gingivitis and periodontitis, is important to overall health.

. Here are some trends in nonsurgical and surgical therapy that will successfully arrest periodontal infections. Opportunities for early diagnosis and prevention will play an increasing role in dental practice in the future as patients understand the importance of oral health to overall health A prospective approach of prevention and early intervention in treating the disease is more important than ever before.

Nonsurgical Therapy: Emerging Trends

Ultrasonics and sonics and topical antimicrobial therapy.

Extensive reviews of the literature have been conducted regarding the use of power driven scalers or manual scalers for root debridement. Results confirmed that calculus and plaque removal can be performed equally well with either manual or power-driven scalers Attachment gains, as well as reductions in probing depths and bleeding on probing have been accomplished with both manual and ultrasonic and sonic scaling.

Topical antimicrobials have emerged as important adjuncts to nonsurgical therapy and are easily delivered in the ultrasonic lavage during instrumentation. Povidone iodine, or PVP-I, and chlorhexidine, or CHX, are both effective topical antiseptics that could potentially be used to enhance results in initial therapy or maintenance patients. Although not yet a strong trend, recent data suggest that antimicrobial toothpastes may be useful in the long-term maintenance of oral health in periodontitis-susceptible patients

Sustained-release local drug delivery. Doxycycline gel and tetracycline fibers, both are types of tetracycline antibiotics used to treat periodontal infections locally. Tetracycline fibers are nonresorbable, whereas the doxycycline gel is resorbable within a short period

In general, all of these delivery systems have reported statistically significant effects on clinical parameters, showing attachment gains, and reduction of bleeding on probing and probing depths. These local antimicrobials are primarily used for treating recurrent isolated pockets of 5 mm or more that bleed upon probing in patients with moderate-to severe adult periodontitis. Trends in nonsurgical therapy include incorporating more anti-infective types of drugs into treatment protocols, which fits the concept of periodontitis as an infection. It should be mentioned that in advanced and early-onset–type periodontitis, these topical and sustained local drug delivery approaches are usually not sufficient to stop or eradicate infection, particularly if some of the more invasive organisms such as P. gingivalis and A. actinomycetemcomitans are present. In the case of infections with these invasive organisms, systemic antibiotics are often needed in combination with surgical débridement to completely eliminate the infection.

Surgical Interventions: Emerging Trends

Periodontal plastic surgery. Trends in surgical periodontics are continuing to expand into the “periodontal plastic surgery” area. Many new techniques have been incorporated into daily practice that are focused on root coverage and pre prosthetic procedures such as ridge preservation or ridge augmentation prior to implant placement or restorations.

Regeneration techniques: new materials.

Regeneration techniques continue to expand the ability of the surgeon to restore lost hard and soft tissues to a much healthier and more functional and esthetic state. Guided tissue regeneration can be accomplished with many different types of materials and techniques.. The techniques most commonly used to correct bony defects consist of placing an autogenous or bone replacement graft into the defect. For smaller three-walled defects, no other material may be needed. For furcation defects or larger defects, clinicians will often choose to add a resorbable or non resorbable membrane to contain the graft material and exclude the epithelial down growth into the defect.

Summary

Dentistry has always been a leader in the health care community in prevention, and has already addressed one of the most prevalent chronic infections worldwide—dental caries. Now we must focus our attention on all infectious oral diseases, which include not only caries, but gingivitis and periodontitis as well.

An Ounce of Prevention!

We will be attending the CDA Convention on April 12 & 13, 2013. We are really excited to learn and have hands on with all the new and update dentistry. We hope you have a GREAT rest of the week and weekend as we know we will!!!

Management of Periodontal Disease

Recent epidemiologic surveys and studies have provided important information on the prevalence, extent, and severity of periodontal diseases in the United States. Over 50% of adults had gingivitis on an average of 3 to 4 teeth. Subgingival calculus was present in 67% of the population. Adult periodontitis, measured by the presence of periodontal pockets ≥ 4 mm, was found in about 30% of the population on an average of 3 to 4 teeth. Severe pockets ≥ 6 mm were found in less than 5% of the population. Attachment loss ≥ 3 mm was found in 40% of the population. Gingival recession accounted for a significant amount of attachment loss. The prevalence of early-onset periodontitis ranged from less than 1% in 14- to 17-year-olds to 3.6% in young adults aged 18 to 34. Extensive and severe periodontitis was much more prevalent in minorities, people with less than a high school education, and those who had seen a dentist infrequently and had subgingival calculus. Smoking and diabetes have been identified as risk factors, especially diabetics with poor metabolic control, a long duration of the disease, and extensive subgingival calculus.

“It is now beyond question that dental plaque is the main etiological factor in the pathogenesis of periodontal disease” says DrCherukuri from her Chino, California dental practice.

The basic approach to periodontal treatment has always been and remains the removal of supra and sub gingival bacterial deposits by scaling and root planing.  Non surgical periodontal treatment is the cornerstone of periodontal therapy and the first recommended approach.  Non surgical periodontal therapy has evolved over the years but still considered the “gold standard” to which all other treatments are compared.

Severe generalized periodontitis is a form of chronic periodontitis that appears to be associated with an exaggerated host response.  The supplements of adjunctive host modulating  agents like Subantimicrobial Dose of Doxycycline provides clinically and statistically significant benefits in the reduction of pockets in patients with severe, generalized periodontitis.

Surgical procedures have been shown to be effective in treating moderate to advanced periodontitis when followed by appropriate maintenance care. Deep pockets of>_ 7mm demonstrate more pocket reduction with surgical flap procedure than compared to scaling and root planning alone.

Decisions for or against soft tissue surgery must be made on the basis of individual patient considerations.

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Implants and Diabetes

Implants are replacement tooth roots which provide a strong foundation for fixed and or removable replacement of teeth.

In general dental implants have a success rate of 98% and with proper care they can last a lifetime.

Anyone healthy enough to undergo a routine dental extraction or oral surgery can be considered for a dental implant. Patients should have healthy gums and enough bone to hold the implant. They also must be committed to good oral hygiene and regular dental visits. Heavy smokers, people suffering from uncontrolled chronic disorders -- such as diabetes or heart disease or patients who have had radiation therapy to the head/neck area need to be evaluated on an individual basis.

Diabetes affects about 15.7 million Americans and nearly 800,000 cases are diagnosed every year.  Diabetes can lower the body’s resistance to infection and can slow the healing process. As a result, periodontal diseases often appear to be more frequent and more severe among persons with diabetes.

Prior to dental implant placement, your dentist may request a test of blood sugar to see whether diabetes is under control and may prescribe antibiotics to minimize the risk of infection. A modification in diet and medication may also be considered to improve healing. Good maintenance of blood sugar levels, a well-balanced diet, good oral care at home and regular dental check- ups significantly improve the chances of implant success.

Additionally, modifications in surgical technique can also enhance and ensure implant success says Dr. Cherukuri, from her Chino, California practice.

Check with your dentist if you are a candidate for implants!